| Breed:
_______________________Sex:_________Call
Name:__________________ |
| AKC Registered
Name: _________________________________________________ |
| AKC #:
____________________________ Date of Birth:
______________________ |
| Breeders:
___________________________________________________________ |
| Owners: (as
appears on AKC Reg.)
________________________________________ |
| Owners Address
(as appears on AKC Reg.)
_________________________________ |
|
_________________________________________________________________ |
| Country of Birth:
________________ Current # of Points: _______ as of
date: _______ |
|
Majors:______________ Judges awarding Majors:
___________________________ |
| Sire:
_______________________________________________________________ |
| Dam:
______________________________________________________________ |
| |
| Date of most
recent inoculations: (Please supply a copy of shot
records, including Rabies)
_____________________________________________________________ |
| Date of most
recent deworming: ____________________ Product used:
___________ |
| Special Issues
for Dog: (Health, Temperament, etc.) ___________________________ |
|
_________________________________________________________________ |
| Name, Address &
Phone Number of Dog's Treating Veterinarian:
_________________ |
|
_________________________________________________________________ |
| Owner Responsible
for Bill:
______________________________________________ |
| Street Address:
(Street, City, State & Zip):
___________________________________ |
|
_________________________________________________________________ |
| Mailing Address:
(P.O. Box, City, State & Zip):
________________________________ |
|
_________________________________________________________________ |
| Owner Home Phone:
________________ Work: ___________ Cell:
______________ |
| Owner Email:
_________________________________________________________ |
| Date:
__________________ Owner Signature:
_______________________________ |
| Date:
__________________ A. Candy Carswell:
_____________________________ |
| |
|
|